Kaplan USMLE Step 2: Best medication for postmenopausal patient

If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.

A 54-year-old woman comes to the physician for an annual gynecologic examination. Since menopause a year ago, the patient has had vaginal dryness and dyspareunia for which she uses an over-the-counter vaginal lubricant. Her last Pap test a year ago was normal.

She has a medical history of lobular carcinoma in situ without evidence of high-risk features that has been observed clinically without evidence of progression on imaging. Her daily medications include oral prednisone for rheumatoid arthritis. Her mother recently had a lumpectomy followed by radiation therapy for breast cancer. Vital signs are within normal limits. A clinical breast examination is normal. A pelvic examination shows the vaginal mucosa to be pale and without rugae. Bone mineral density by dual-energy x-ray absorptiometry shows a T-score of -2 at the femoral neck.

Which of the following is the most appropriate pharmacotherapy?

A. Alendronate

B. Anastrozole

C. Estradiol

D. Raloxifene

E. Tamoxifen

The correct answer is D.

Raloxifene is the first-line therapy for postmenopausal women who require chemoprophylaxis for both breast cancer and osteoporosis, without increasing the risk for endometrial hyperplasia.

Choice A. Alendronate is a bisphosphonate that is indicated for the prevention and treatment of osteoporosis. However, it does not affect breast cancer risk and is, therefore, not the most appropriate treatment for this patient.